Comparison of Plantar Pressure Distribution and Ultrasonographic and Clinical Features After Application of Different Energy Levels of Extracorporeal Shockwave Therapy in Patients with Plantar Fasciitis: A Randomized, Prospective, Double-Blind Clinical Trial

Background: The effectiveness of different energy levels used in extracorporeal shockwave therapy (ESWT) has been investigated in previous studies, but controversy remains regarding which energy levels should be used in the treatment of plantar fasciitis. We compared the efficacy of different energy levels used in ESWT in the treatment of plantar fasciitis using plantar fascia thickness and pressure distribution. Methods: Between July 2021 and September 2021, a total of 51 patients (71 feet) with plantar fasciitis were randomized into three treatment groups using the sealed envelope method. Group 1 (n = 25) received low energy density (0.09 mJ/mm(2) ), group 2 (n = 25) received medium energy density (0.18 mJ/mm( 2) ), and group 3 (n = 21) received high energy density (0.38 mJ/mm(2) ). Each group received three sessions of ESWT at a frequency of 2,000 shocks per minute at 1 -week intervals. Patients were evaluated before and after treatment using a visual analog scale (VAS) for pain, the Foot Function Index (FFI), plantar fascia thickness measured by ultrasonography, and plantar pressure distribution. Results: Posttreatment VAS and FFI scores were determined to be significantly lower than the values before treatment in the three groups ( P < .001). There were no significant differences among groups in pretreatment and posttreatment values of VAS, FFI, plantar fascia thickness, and pressure distribution ( P > .05). No significant differences were found among groups in percentage changes in all of the outcome parameters ( P > .05). Conclusions: There was no superiority among low, medium, or high levels of ESWT in terms of pain, foot functions, fascia thickness, and pressure distribution in the treatment of plantar fasciitis.